Transcription
Humana’s Ultimate Guideto the Medicare AdvantageOpen Enrollment Period (OEP)Partner/Career Agents OEP Guide
ContentsSkip to the section you want with a single click.Introduction . 3OEP 101 . 4Marketing Guardrails During OEP . 7OEP Compliance . 12Enrollment Guidance . 18Conclusion . 202 FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY
IntroductionAre you ready to rock the new year? It starts with OEP. During OEP, Medicarebeneficiaries who are dissatisfied with their current plan can join or leavea Medicare Advantage (MA) plan, giving them the freedom and flexibilityto find the plan that fits their needs. Discover what you can do to help clientsfind plans that work, while remaining CMS compliant. Want to find out moreabout OEP? Let’s go.FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY 3
SECTION 1OEP 101Understanding how OEP works will help you provide your clients with the plansthey want, while making sure you remain compliant. Check out the answers tosome of the OEP basics.4 FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY
Who can use the MA OEP? Individuals enrolled in an MA or MAPD plan New Medicare beneficiaries who enrolled in an MA or MAPD plan during theirInitial Coverage Election Period (ICEP) and the Intial Enrollment Period (IEP)Who cannot use the MA OEP? People enrolled in Original Medicare only Prescription Drug Plan (PDP) enrollees Medicare Supplement enrollees Those enrolled in Medicare Savings Accounts or other Medicare health plantypes such as cost plans or PACEWhen does OEP occur? January 1–March 31FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY 5
What can MA/MAPD enrolleesdo during OEP? Switch from one MA/MAPD plan to another Go back to Original Medicare with or withouta stand-alone PDP/MAPD plansWhat can’t enrollees doduring OEP?PRO TIPUse Humana’sFind a Doctor toolwith Care HighlightTMratings to find in-networkproviders who are right for yourclients and their unique needs. Switch from Original Medicare to a MedicareAdvantage Plan Join a Medicare drug plan if they’re in Original Medicare Switch from one PDP to another if they’re in Original MedicareWhy might MA/MAPD enrollees want to switchduring OEP?MA enrollees may have different reasons for changing plans during OEP. The rate of rapiddisenrollment, where clients switch plans after a few months, can range from 5–30%.2This can be caused by a number of factors, including, but not limited to: Their doctor is not in their plan network Their prescription drugs are not on their plan formulary Their plan benefits may have drastically changed The consumer didn’t fully understand or wasn’t told how the plan workedHow should Agents respond to clients who want toswitch MA/MAPD plans or enroll in a stand-alone PDP?If a client expresses dissatisfaction with their plan, this is a great time to understandtheir needs and help them find a plan that fits their criteria. You can use Humana’sonline enrollment tools, now with electronic and telephonic signature options, to ensureefficiency, accuracy and transparency: Digital Marketing Materials Enrollment tanding-rapid-disenrollment6 FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY
SECTION 2Marketing GuardrailsDuring OEPIt’s important to know how to handle marketing during OEP. Check outthis section to discover what you can and cannot do when it comes toOEP marketing.FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY 7
During OEP, Agents MAY:333Market to Age-Ins who have not yet madean enrollment decision.Market five-star continuous enrollmentSpecial Enrollment Period (SEP)(if applicable).Market to dual-eligible (Medicare andMedicaid eligible) and Low-Income Subsidy(LIS)/Extra Help beneficiaries who maymake changes once per calendar quarterduring the first nine months of the year.3Send marketing materials when abeneficiary makes a proactive request.3At the beneficiary’s request, have one-on-one meetings with the beneficiary.3At the beneficiary’s request, provide information on OEP.3Include general educational information on their website (Partner Agents only)about OEP as long as it is in the context of providing information about otherenrollment periods.8 FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY
PRO TIP Use pre-approved, customizable, ready-to-use traditional anddigital marketing materials from Humana’s Marketing ResourceCenter (MRC) for compliant communications. Materials areavailable in more than 20 languages, including Spanish, Koreanand traditional Chinese. Search for Age-In, DSNP, Low-Income Subsidy/Extra Help andSEP in the MRC for marketing materials to use during OEP. Agents who signed up for Humana’s Reach Rewards program*earn points for every MRC order and MRC download. Use Humana’s online enrollment tools such as Digital MarketingMaterials and Enrollment Hub to help clients switch from oneMA plan to another. Earn Reach Rewards* points for every onlineenrollment. Save time with like-to-like plan changes using Humana’s Agentof Record pledge and this plan-to-plan client-facing flyer.*Subject to Reach Rewards terms and conditions. Limits may apply.FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY 9
During OEP, Agents MAY NOT:XSend unsolicited materials referencing OEP or advertising the abilityto switch plans.XCall or contact former enrollees who selected a new plan during AEP.XTarget beneficiaries who are in the OEP due to making a choiceduring AEP.XEngage in or promote Agent activities to target the OEP as anopportunity to make further sales.10 FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY
“Kindness and courtesy areat the root of a positivecustomer service experience.”- Shep HykenFOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY 11
SECTION 3OEP ComplianceOEP compliance is important to make sure your clients’ best interests comefirst. Find out what you need to do to adhere to CMS compliance policies andmaintain your good standing.12 FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY
Outside of OEPGet answers to frequently asked questions on marketing and communications outsideof OEP here.1. Can Agents inform consumers during AEP about OEP?Information related to OEP can only be included as part of a general discussion of electionperiods. Election Periods may include but are not limited to: Newly eligible to Medicare (Age-In or disability) Client moved Natural disasters Loss in coverage Change in dual-eligible or low-income statusLearn more about election periods at Medicare.gov.2. Can Agents inform consumers about OEP during AEP appointments (whichcould be in person, telephonic and/or virtual)?An Agent may only mention OEP during an AEP appointment if the beneficiary specificallyasks what their enrollment and/or disenrollment options are outside of AEP. If that occurs,the Agent may say “AEP ends on December 7. But if you are enrolled in an MA or MAPDplan, you are allowed to make one plan change during OEP, which runs from January 1–March 31 each year.” Individuals who first enroll in an MA or MAPD as part of their ICEPduring the annual OEP may make a change during that election period, which runs fromJanuary 1–March 31 each year.3. Can Agents advise current or prospective clients between AEP and OEP(December 8–31) to contact them during OEP if they want to make a planchange?No, this would be considered a sales-targeting activity and is prohibited.4. Can Agents obtain Permission to Contact forms to contact someoneduring OEP?No, this would be considered a sales-targeting activity and is prohibited.FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY 13
Working with Clients During OEPFind out what you can say and do during OEP with current and prospective clients below.1. Agents frequently contact their Book of Business post-enrollment to seehow their plan is working. During OEP, can Agents inform clients they canmake a plan change if they are not satisfied?The beneficiary must first indicate dissatisfaction with their selected plan. The Agent maythen discuss all applicable election periods with the client (SEP, OEP, etc).2. What are examples of beneficiary dissatisfaction you might hear? “I really don’t like this PPO plan. Can I pick another one?” “Do I have to keep this plan until October or can I change before then?”Whenever a client expresses dissatisfaction with their selected plan, an Agent can discuss allapplicable election periods. To avoid rapid disenrollment and/or future dissatisfaction, makea habit to discuss providers and prescriptions compliantly during sales appointments. Askthese questions and use these tools:PROVIDERSAsk: “Would you like me to look up any providers to confirm theyare in the plan’s network?”Tool: Humana’s Find a Doctor tool with Care HighlightTM ratings.PRESCRIPTIONSAsk: “Would you like me to look up any prescriptions to confirmthey are on the plan’s formulary?”Tool: Humana’s Rx Calculator.14 FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY
PRO TIPAsk clients for their consent to save their drug list to Rx Calculator. Druglist consent helps Humana provide personalized, proactive supportabout a client’s drug list to help them potentially save money on fillingprescriptions and enhance the client experience. (Reminder: Beneficiariesare not required to provide drug list consent to use Rx Calculator.)3. What if someone expresses concern about their current plan? Can theAgent state that they have a one-time election period to make a changeduring OEP?If a beneficiary expresses dissatisfaction with their selected plan, an Agent can discuss allapplicable election periods.4. I was unable to reach some of my existing MA/MAPD clients during AEP.May I contact them to discuss their options during OEP?No, you may not market the ability to make a plan change during OEP. However, you maycontact your clients as part of your normal client retention outreach to see how they aredoing with their current plan. If they express dissatisfaction, you may discuss all applicableelection periods (SEP, OEP, etc).5. If a client on an MA/MAPD plan did not make a change during AEP, canthey make a change during OEP?Yes, individuals enrolled in an MA or MAPD plan or new Medicare beneficiaries who areenrolled in an MA/MAPD plan during their IEP or ICEP who are not satisfied with their currentMA/MAPD plan can use the OEP to make a change.FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY 15
6. Humana collaborated with Walmart and Kroger to allow Agents to stafftables at retail stores during AEP. Can staffing at retail stores continueduring OEP?Yes, Agents can continue to staff stores as long as they are not proactively advertising orasking/approaching individuals about OEP. Agents can respond to questions regarding an SEPor, if someone asks, about OEP.7. Can informal marketing events still occur during OEP?Yes, but Agents can only discuss election periods (SEP, OEP, etc.) with the consumer if theyask about their plan-change options. Informal events may include, but are not limited to:In-person events: retail store table, kiosks, Humana RVs, local events (flea market, farmer’smarket, fair, etc.). Be sure to follow CDC, Humana, state and local guidelines.Virtual events: educational events about Medicare or general health and wellness(does not include sales seminar events).8. What does an Agent need to do during OEP to demonstrate that they aremarketing an SEP rather than OEP?The Agent needs to make it clear that the marketing is for those who quality for an SEP.The content presented should not focus primarily or exclusively on the OEP. This applies tomarketing materials as well as informal in-person or virtual events.9. Can an Agent wear a button, have a sign, send a marketing piece or socialmedia post that says something like “Ask me about OEP” or “OEP?”No. The Agent could use something that says “Ask me about Medicare Plans.” To find thesetypes of materials, search the MRC for pre-approved, customizable content including eventsignage and giveaway items.16 FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY
OEP Agent/Provider ActivitiesProviders should always consult with their own legal and compliance teams regarding anyevents to ensure compliance with all applicable guidelines, including CMS and Office ofInspector General (OIG) guidelines.1. Can Humana sales Agents participate in a provider practice new-patientonboarding or patient-appreciation events during OEP?Yes, Agents are permitted to participate in a sales/marketing or educational capacity inprovider offices and events, as long as they are not advertising or asking/approachingindividuals about OEP and all CMS and Humana event guidelines are followed. Agents shouldadvise the provider practice that the provider should also not discuss the OEP at the event.Agents can respond to questions regarding an SEP or, if someone requests, about the OEP. Inaddition, Agents should not specifically target those who have already made a plan electionduring AEP. Agents must use approved materials when conducting any educational or sales/marketing events. Events may be virtual or in-person (following all CDC, Humana, state andlocal guidelines).FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY 17
SECTION 4Enrollment GuidanceCheck out these questions to get answers on what to do during OEP.18 FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY
1. CMS guidance indicates the effective date for an MA OEP election is thefirst of the month following receipt of the enrollment request. Does thatmean an application received by the Agent or Humana on March 1 wouldhave an April 1 effective date?Correct, per Chapter 2 Enrollment Manual section 30.5, “The effective date for an MA OEPelection is the first of the month following receipt of the enrollment request.”2. If a client submits two applications during OEP, is the application dateor received date honored? For instance, what happens if a client submits apaper application with one Agent and then calls another Agent right afterand submits a telephonic application?The date an application is received and processed is used to honor the enrollee’s request.Per Chapter 2 Enrollment Manual Section 30.5, “Individuals may make only one electionduring the MA OEP.” Whichever “complete” application (per CMS guidance) is received andprocessed first will exhaust the enrollee’s one OEP election.PRO TIPUse Humana’s online tools such as Digital Marketing Materials andEnrollment Hub to ensure the most efficient, accurate and transparentapplication processing.3. Will a trial period exist for OEP since consumers are only able to make aone-time switch? In other words, if a consumer switches from one MA plan toanother MA plan and is unhappy with the new plan, can they go back to theirfirst MA plan?No, per Chapter 2 Enrollment Manual section 30.5, enrollees have only one OEP election.There is no trial-period provision with MA/PD products. The trial period is only for those whodropped a Medicare Supplement plan after enrolling in an MA/MAPD for the first time andwho are still within 12 months of that first MA/MAPD enrollment. Clients are “locked in” oncethe one OEP election is used unless they have another valid election period.FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY 19
ConclusionRemember to start the year out right. Providing proactive customer service withcheck-ins helps clients get the most out of their plan benefits, and listeningto their needs creates client retention and could lead to more client referrals.Want to learn more? We’ve got your back, with the 3-30-60-90-day guide,our retention podcast or you can search for other retention content atIgnitewithHumana.com.It’s about the humans.That’s human care.That’s fault.aspx#gsc.tab nding-rapid-disenrollment20 FOR AGENT USE ONLY - DO NOT DISTRIBUTE - CONFIDENTIAL AND PROPRIETARY
Use Humana’s online enrollment tools such as Digital Marketing Materials and Enrollment Hub to help clients switch from one MA plan to another. Earn Reach Rewards* points for every online enrollment. Save time with like-to-like plan changes using Humana’s Agent of Record
